EP0791342B1 - Femoral neck endoprosthesis for an artificial hip joint - Google Patents

Femoral neck endoprosthesis for an artificial hip joint Download PDF

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Publication number
EP0791342B1
EP0791342B1 EP19970100111 EP97100111A EP0791342B1 EP 0791342 B1 EP0791342 B1 EP 0791342B1 EP 19970100111 EP19970100111 EP 19970100111 EP 97100111 A EP97100111 A EP 97100111A EP 0791342 B1 EP0791342 B1 EP 0791342B1
Authority
EP
European Patent Office
Prior art keywords
femoral neck
shell
femur
sleeve
adapter
Prior art date
Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
Expired - Lifetime
Application number
EP19970100111
Other languages
German (de)
French (fr)
Other versions
EP0791342A1 (en
Inventor
Hans Dr. Grundei
Jörg SCHOLZ
Current Assignee (The listed assignees may be inaccurate. Google has not performed a legal analysis and makes no representation or warranty as to the accuracy of the list.)
ESKA Implants GmbH and Co
Original Assignee
ESKA Implants GmbH and Co
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority to DE19601340 priority Critical
Priority to DE1996101340 priority patent/DE19601340C1/en
Application filed by ESKA Implants GmbH and Co filed Critical ESKA Implants GmbH and Co
Publication of EP0791342A1 publication Critical patent/EP0791342A1/en
Application granted granted Critical
Publication of EP0791342B1 publication Critical patent/EP0791342B1/en
Anticipated expiration legal-status Critical
Application status is Expired - Lifetime legal-status Critical

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    • AHUMAN NECESSITIES
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/36Femoral heads ; Femoral endoprostheses
    • A61F2/3601Femoral heads ; Femoral endoprostheses for replacing only the epiphyseal or metaphyseal parts of the femur, e.g. endoprosthetic femoral heads or necks directly fixed to the natural femur by internal fixation devices
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    • A61B17/58Surgical instruments or methods for treatment of bones or joints; Devices specially adapted therefor for osteosynthesis, e.g. bone plates, screws, setting implements or the like
    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
    • A61B17/74Devices for the head or neck or trochanter of the femur
    • A61B17/742Devices for the head or neck or trochanter of the femur having one or more longitudinal elements oriented along or parallel to the axis of the neck
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    • A61B17/68Internal fixation devices, including fasteners and spinal fixators, even if a part thereof projects from the skin
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/00Filters implantable into blood vessels; Prostheses, i.e. artificial substitutes or replacements for parts of the body; Appliances for connecting them with the body; Devices providing patency to, or preventing collapsing of, tubular structures of the body, e.g. stents
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    • A61F2/46Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor
    • A61F2002/4635Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using minimally invasive surgery
    • A61F2002/4636Special tools or methods for implanting or extracting artificial joints, accessories, bone grafts or substitutes, or particular adaptations therefor using minimally invasive surgery through the hip femoral neck
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    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0033Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements made by longitudinally pushing a protrusion into a complementary-shaped recess, e.g. held by friction fit
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    • A61F2220/0025Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements
    • A61F2220/0041Connections or couplings between prosthetic parts, e.g. between modular parts; Connecting elements using additional screws, bolts, dowels or rivets, e.g. connecting screws
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    • A61F2230/0067Three-dimensional shapes conical

Description

Die Erfindung betrifft eine Schenkelhalsendoprothese für ein künstliches Hüftgelenk. The invention relates to a femoral neck for a hip replacement.

Zur Behandlung eines distruierten, dh zerstörten Hüftgelenkskopf, woraus erhebliche Schmerzempfindungen und gravierende funktionelle Einschränkungen des Gelenks resultieren, haben sich im wesentlichen zwei Therapiemöglichkeiten während der letzten Jahrzehnte durchgesetzt: For treating a distruierten, ie destroyed hip joint head, from which results in considerable pain sensations and serious functional limitation of the joint, have become established in the two main treatment options during the last decades:

Zum einen ist es möglich, den Patienten mit einer Orthese zu versorgen, dh also mit einem externen Stützapparat. On the one hand it is possible to provide the patient with an orthotic, ie with an external brace. Neben der Tatsache, daß diese Versorgungsmöglichkeit kosmetisch völlig unakzeptabel ist, ist sie auch versorgungstechnisch nur suboptimal. Besides the fact that this supply option is cosmetically completely unacceptable, it is also supply technically suboptimal.

Als weitere, weitverbreitetere Möglichkeit ist vorgesehen, den Patienten mit einer Endoprothese zu versorgen, namentlich mit einer Hüftstielendoprothese, bei welcher ein Stiel in den zuvor freigeräumten Knochenmarksraum des Femurs eingesetzt wird und dort zementlos oder unter Verwendung eines Zements fixiert wird. As a further, more widespread possibility is provided for providing the patient with an endoprosthesis, in particular with a Hüftstielendoprothese in which a stick is inserted in the above the cleared bone marrow cavity of the femur, and is fixed there without cement or using cement. An der proximalen Seite weist eine derartige Endoprothese dann die Möglichkeit des Anschlusses einer künstlichen Gelenkkugel vor. On the proximal side, such a endoprosthesis then present the possibility of connecting an artificial joint ball.

Gerade die letzte Möglichkeit ist stark in der Patentliteratur vertreten. This last possibility is strongly represented in the patent literature. An dieser Stelle sei nur beispielhaft auf die DE-U-94 12 408 hingewiesen It should be exemplary only made to DE-U-94 12 408

Unter den einen oder anderen der in der Patentliteratur vorgeschlagenen Hüftstielendoprothesen gibt es einige Ansätze, die recht vielversprechend sind im Hinblick auf die Langzeitstabilität im Patientenkörper. Among the one or the other of the measures proposed in the patent literature hip stem endoprostheses there are some approaches that are quite promising in terms of long-term stability in the patient's body. Früher oder später jedoch, beispielsweise nach 10 bis 15 Jahren, ist zu beobachten, daß die Endoprothese einem Verschleiß unterworfen ist, welcher zu der Notwendigkeit führt, in einem Revisionseingriff die implantierte Endoprothese zu entfernen und durch eine neue zu ersetzen. Sooner or later, however, for example, after 10 to 15 years, it is observed that the endoprosthesis is subject to wear, which leads to the need to remove in a revision surgery, the implanted endoprosthesis and replace it with a new one. Dies ist freilich nicht ganz unproblematisch, da durch die Resektion und Ausräumung des Knochenmarkraumes ein nicht unerheblicher Anteil natürlichen Knochenmaterials bei der Erstimplantation entfernt worden ist. This is of course not without its problems, since by the resection and removal of the bone marrow of a considerable portion of natural bone material at the first implantation has been removed. Das einmal entfernte Material fehlt dann unter Umständen bei einem Revisionseingriff. The once removed material is then missing under circumstances in a revision surgery. Dies kommt insbesondere dann zum Tragen, wenn die Patienten relativ jung sind, bei denen also von vorn herein davon auszugehen ist, daß sie im Laufe ihres Lebens mindestens einem Revisionseingriff unterworfen werden müssen. This is particularly evident when the patients are relatively young, which is thus in assumed from the very fact that they have to be subjected to at least one revision surgery in their lifetime.

Eine Endoprothese, die mit einer geringfügigeren Resektion natürlichen Knochermaterials auskommt als die bekannten Hüftstielendoprothesen ist bekannt geworden aus der DE-A-27 24 234 sowie aus der EP-A-0099167. A stent, which requires only a minor resection natural Knochermaterials than the known hip stem endoprostheses is known from DE-A-27 24 234 and from EP-A-0,099,167th Das darin beschriebene Prothesenteil wird im oberen Bereich eines Femurs, aber unterhalb des Trochanter minors implantiert, ohne daß ein Stiel in den Knochermarksraum reichen würde. The prosthetic component described therein is implanted minors in the upper region of a femur below the trochanter but without a stem would be enough in the Knochermarksraum. Diese auch als Druckscheibenprothese bezeichnete Prothese greift im wesentlichen mit einer proximalen Druckplatte über die Kortikalis des resezierten Femurs im Bereich des entfernten Hüftgelenkkopfes. This is also referred to as a disc prosthesis prosthesis engages substantially with a proximal pressure plate over the cortical bone of the resected femur in the region of the removed femoral head. Sie wird mit einer Druckplatte, die lateral am Femur anliegt, verspannt, derart, daß alle mechanischen Kräfte zwischen der Endoprothese und dem Femur direkt in die Kortikalschicht des Femurs eingeleitet werden, wodurch eine als unzulässig empfundene mechanische Beanspruchung der Spongiosa vermieden werden soll. It is equipped with a pressure plate which rests laterally on the femur, clamped, so that all the mechanical forces between the endoprosthesis and the femur be introduced directly into the cortical layer of the femur, which is perceived as inadmissible mechanical strain of the cancellous bone to be avoided. Lediglich eine geringe Menge von Knochenzement ist für die Arretierung der Druckscheibe im proximalen Bereich notwendig. Only a small amount of bone cement is necessary for securing the pressure plate in the proximal region.

Der Philosophie dieser Prothese liegt - wie ausgeführt - die Annahme zugrunde, daß die Spongiosa des Femurs möglichst wenig beansprucht werden soll. The philosophy of this prosthesis is - as stated - on the assumption that the cancellous bone of the femur to be little strain as possible. Dies wird erkauft durch eine extreme Belastung der Kortikalis des Femurs, indem nämlich sämtliche Kräfte darauf abgelastet und darin eingeleitet werden. This is paid for by an extreme load on the cortex of the femur by namely all forces are derated it and launched it. Dies entspricht nach heutiger Erkenntnis in keiner Weise den natürlichen Belastungsverhältnissen. This corresponds to the latest findings in any way the natural load conditions.

Eine ganz ähnlich wirkende Prothese zeigt im übrigen die WO 89/11837, bei der die Funktion der proximalen Druckplatte gemäß der vorerwähnten Druckschrift wahrgenommen wird durch den speziell ausgebildeten Hüftgelenkkopf, der innenseitig mit einer Ausnehmung versehen ist, an der sich innenseitig der resizierte Femurstumpf unter Druckerzeugung anlegt. A very similar effect prosthesis moreover shows the WO 89/11837, in which the function of proximal pressure plate according to the aforementioned document, it is perceived by the specially trained hip joint head, which is provided on the inside with a recess at which the inside of the resected femoral stump under pressure generating invests.

Zwei Prothesen, bei denen augenscheinlich die Hauptlast von der Spongiosa des Femurknochens aufgenommen werden soll, sind bekanntgeworden aus der FR 26 26 169 A1 und der FR 26 74 122 A1. Two prostheses, in which evidently the main load to be absorbed by the spongy bone of the femur have become known from FR 26 26 169 A1 and FR 26 74 122 A1. Bei der erstgenannten Druckschrift der beiden ist vorgesehen, einen proximal einen Steckkonus aufweisenden Gewindebolzen in die Spongiosa einzuschrauben. In the former publication of the two is provided to screw in a proximal cone having a male threaded bolt in the cancellous bone. Dies dürfte innerhalb kürzester Zeit zu schweren Instabilitätsproblemen führen. This should result in a very short time to serious instability problems. Bei der zweitgenannten Druckschrift der beiden wird eine einen Steckkonus tragende Platte mittels einer Reihe von Knochenschrauben befestigt, wobei die Knochenschrauben in die Spongiosa reichen. In the second-mentioned publication of the two an a plug cone bearing plate is secured by means of a series of bone screws, the bone screws extend into the cancellous bone. Auch hieraus ergeben sich ernsthafte Stabilitätsfragen, da die Spongiosa von Natur aus im Verhältnis zur Kortikalis des Femurknochens punktuell nur gering belastbar ist. Also, whereas this results in serious stability issues, as the cancellous bone is inherently targets only low loads relative to the cortex of the femur bone.

Vor diesem Hintergrund ist es daher die Aufgabe der vorliegenden Erfindung, eine Schenkelhalsendoprothese für ein künstliches Hüftgelenk anzugeben, die sich hinsichtlich der Krafteinleitung in den Femur bei nur relativ geringfügig notwendig werdenden Resektionen von natürlichen Knochenmaterial den natürlichen Verhältnissen erheblich besser anpaßt als die vorerwähnte Prothese. Against this background, it is therefore the object of the present invention to provide a femoral neck endoprosthesis for an artificial hip joint, which is the natural conditions considerably better conform with regard to the introduction of force into the femur in expectant only relatively slightly necessary resections of natural bone material than the above-mentioned prosthesis.

Gelöst wird diese Aufgabe dadurch, daß die Schenkelhalsendoprothese aufweist: This object is achieved in that the femoral neck endoprosthesis has solved:

  • eine zementlos im oberen Bereich eines Femurs unterhalb des Trochanter minors implantierbare Hülse, mit deren proximalen Ende ein Adapter zur Aufnahme einer künstlichen Gelenkkugel verbunden ist, wobei die Hülsenaußenseite zumindest teilweise mit einer offenmaschigen dreidimensionalen Raumnetzstruktur belegt ist, sowie a is connected without cement in the upper region of a femur below the trochanter minors implantable sleeve, with the proximal end of an adapter for accommodating an artificial joint ball, the sleeve outer surface is at least partially covered with an open-meshed three-dimensional spatial network structure, as well as
  • eine Zugplatte, an der eine Zugschraube angeschlagen ist, die durch eine Durchbohrung im distalen Ende der Hülse in deren Inneres gesetzt und mit einem dort vorgesehenen Gewinde verschraubt ist, wobei a draw plate on which a draw-in screw is struck, which is set through a through bore of the sleeve in the distal end into the interior thereof and is screwed with a thread provided therein, wherein
  • sie proximalseitig keine Druckplatte zum Einleiten von Druckkräften auf die Kortikalis des Femurs aufweist. it has no printing plate for introducing compressive forces on the cortex of the femur proximally.

Im Gegensatz zu der oben beschriebenen Druckscheibenendoprothese werden die Belastungskräfte nicht in die Kortikalis des Femurs eingeleitet, sondern direkt in die Spongiosa im Inneren des Femurs, nachdem Knochentrapekel während der Einheilungsphase durch die offenmaschige dreidimensionale Raumnetzstruktur auf der Hülsenaußenseite gewachsen ist. In contrast to the above-described Druckscheibenendoprothese the load forces are not introduced into the cortex of the femur, but directly into the cancellous bone inside the femur after trabecular bones grown on the sleeve outer surface during the healing through the open-mesh three-dimensional network structure. Es wird also mit der erfindungsgemäßen Endoprothese genau der Weg beschrieben, welcher in der DE-27 24 234 als nachteilig angesehen worden ist, nämlich die Spongiosa zu belasten. It is thus described the inventive endoprosthesis exactly the way that has been regarded as disadvantageous in DE-27 24 234, which is to strain the cancellous bone. Nach der Einheilphase verhält sich die Hülse der Endoprothese in Nachbildung der natürlichen Verhältnisse aufgrund ihrer quasi Aufhängung an vielen Knochentrapekeln dynamisch, dh sie kann abhängig von den jeweiligen Belastungen ausweichende Bewegungen durchaus nachvollziehen und Ausgleichsbewegungen vollführen. After the healing, the sleeve of the stent behaves in imitation of the natural conditions due to their quasi suspension on many bone trabeculae dynamic, meaning that they can depend trace of the respective loads evasive movements well and perform compensating movements. Diese Art der Fixation einer Endoprothese entspricht den neueren Erkenntnissen aus der Chirurgie, daß nämlich in einem Röhrenknochen die Hauptlasten nicht von der Kortikalis, sondern von der Spongiosa aufgenommen werden. This type of fixation of an endoprosthesis corresponds to the recent findings from the surgery, namely that the main loads are not taken up by the cortical bone, but from the cancellous bone in a long bone. Es findet mit der erfindungsgemäßen Endoprothese keine Druckbeaufschlagung der Kortikalis statt. There is no pressure of the cortex with the inventive endoprosthesis.

Zur Vorbereitung der Implantation wird zunächst der zerstörte Femurkopf durch eine subcapitale Resektion entfernt, und zwar im wesentlichen orthograd zur Schenkelhalsachse. In preparation for implantation of the femoral head is first destroyed removed by a subcapital resection, namely substantially ortho degrees to the femoral neck axis. Sodann wird mittels eines Fräsers, der eine im wesentlichen gleiche Außenkontur wie die zu implantierende Hülse aufweist, in den Schenkelhals getrieben und eine entsprechende Bohrung oder Aushöhlung in der Spongiosa des Femurs hergestellt. Then, driven by means of a milling cutter, which has a substantially same outer contour as the sleeve to be implanted in the femoral neck and a corresponding hole or cavity in the cancellous bone of the femur produced. Sodann kann die Hülse in den ausgefrästen Raum im Schenkelhals gesetzt werden. Then can be placed in the femoral neck, the sleeve in the milled area. Zur lateralen Festlegung der Hülse ist vorgesehen, von außen an den Femur die erwähnte Zugplatte anzulegen, welche mittels einer Zugschraube mit dem Inneren der Hülse verschraubbar ist. For lateral fixing of the sleeve is provided to apply the said tension plate to the outside of the femur, which is screwed by means of a lag screw with the interior of the sleeve. Zu diesem Zweck muß die Kortikalis lateral aufgebohrt werden, so daß die Zugschraube durch die Kortikalis in das Innere der Hülse geführt werden kann, um dort verschraubt zu werden. For this purpose, the cortical bone must be drilled laterally, so that the tension screw can be passed through the cortical bone into the interior of the sleeve to be screwed therein. Die Zugplatte bildet mit der Zugschraube ein im Prinzip bekanntes System der Zuggurtung. The tension plate forms with the lag screw a known in principle system of the tension band.

Der mit dem proximalen Ende der Hülse zu verbindende Adapter kann beliebige geeignete Formen annehmen. The to be connected to the proximal end of the sleeve adapter can have any suitable shapes. Generell ist jedoch darauf zu achten, daß keinerlei Effekte wie bei der Druckscheibe entstehen, wie sie aus der genannten DE-A-27 24 234 bekannt sind. Generally, however, to ensure that no effects as the thrust washer arise as DE-A-27 24 234 are known from above.

Die Hülse sollte vorteilhafterweise im Querschnitt eine ovalförmige Gestalt haben. The sleeve should advantageously in cross section have an oval shape. Hierdurch wird von vornherein eine Rotationsstabilität der Hülse in der Spongiosa erzielt. In this way, a rotational stability of the sleeve is achieved in the cancellous bone from the outset.

Bevorzugt ist im übrigen die Ausbildung der Hülse derart, daß sie sich von ihrem proximalen Ende hin zu ihrem distalen Ende konisch verjüngt. Preferably, the formation of the sleeve, in the rest is such that it tapers from its proximal end toward its distal end tapered. Zum einen entspricht dies der mehr oder weniger konischen Ausbildung des Schenkelhalses, stellt also eine anatomische Adaption dar. Zum anderen wird durch Flächenpressung während der Einheilphase die Kräfteverteilung günstiger wie bei einer Osteosynthese, wenn die Hülse mit der Zugschraube verspannt ist und unter Belastung gesetzt wird, als wenn die Hülse beispielsweise zylindrisch ausgeformt ist. For one, this corresponds to the more or less conical shape of the femoral neck, thus represents an anatomical adaptation. Secondly, the distribution of forces is effective as an osteosynthesis by surface pressure during the healing, when the sleeve with the lag screw is tightened and placed under load, as when the sleeve is, for example, cylindrically formed.

Die Raumnetzstruktur auf der Hülsenaußenseite muß nicht von homogener Maschigkeit sein. The network structure on the sleeve outer surface need not be homogeneous Maschigkeit. Vielmehr wird gemäß einer vorteilhaften Weiterbildung vorgesehen, daß die Raumnetzstruktur auf den nach kaudal und nach kranial (also nach oben und nach unten) weisenden Hülsenaußenseiten grobmaschig mit Maschenweiten zwischen 3 bis 6 mm ausgebildet ist. Rather, it is provided according to an advantageous further development of the spatial network structure is formed on the (that is upward and downward) facing caudal and cephalad sleeve outer sides of coarse mesh having mesh widths between 3 to 6 mm. Dies entspricht den Hauptbelastungsrichtungen der Hülse in dem natürlichen Spongiosabett im Femur und den Trajektorien des Spongiosagewebes des natürlichen Implantat-Lagers im Femur. This corresponds to the main stress directions of the sleeve in the natural Spongiosabett in the femur and the trajectories of the Spongiosagewebes the natural bearing implant in the femur.

Als eine weitere anatomische Adaption ist vorteilhaft vorgesehen, daß die Raumnetzstruktur in Richtung ventral und dorsal auf der Hülsenaußenseite feinmaschig mit Maschenweiten zwischen 1 bis 2,5 mm ausgebildet ist. As a further anatomical adaptation is advantageously provided that the spatial network structure is formed in the direction ventrally and dorsally on the sleeve outer side of a fine mesh having mesh widths between 1 to 2.5 mm. Die bereits angesprochene Ovalform des Querschnittes der Hülse ergibt sich bei der Ausbildung der Raumnetzstruktur auf der Hülsenaußenseite mit zwei unterschiedlichen Maschenweiten in diesem Falle von selbst. In diesem Falle wäre die größere Hauptachse des Oval zu suchen in den Bereichen, in denen die grobmaschige Raumnetzstruktur angeordnet ist, die kleinere Nebenachse hingegen bei den kleineren Maschenweiten. The already mentioned oval shape of the cross section of the sleeve results in the formation of the spatial network structure on the sleeve outer surface with two different mesh sizes in this case by themselves. In this case, the larger major axis of the oval to be sought in the areas in which the coarse-mesh spatial network structure is arranged the smaller minor axis contrast with the smaller mesh sizes.

Bei besonders bevorzugter Ausbildung ist vorgesehen, daß der Adapter für die Gelenkkugel im wesentlichen als Doppelsteckkonus ausgebildet ist mit einem an den beiden Konusbasen umlaufenden Flansch, wobei im proximalen Bereich der Hülse eine dem einen Steckkonus entsprechend ausgebildete konische Steckhülse vorgesehen ist. In a particularly preferred embodiment is provided in that the adapter for the joint ball is designed essentially as a double plug cone having a circumferential at the two cone bases flange, wherein an accordingly formed a plug cone conical plug-in sleeve is provided in the proximal region of the sleeve. Zwischen dem einen Steckkonus und der Steckhülse in der Hülse kann also eine konische Klemmverbindung nach bekannten Prinzipien hergestellt werden, wohingegen der andere Steckkonus mit einer Steckhülse in einem künstlichen Gelenkkopf zusammenarbeitet. Between the one plug cone and the plug-in sleeve in the sleeve can therefore a conical clamping connection according to known principles are produced, whereas the other plug-in cone cooperating with a socket in an artificial joint head.

Zu bemerken ist hierbei folgendes: der an den beiden Konusbasen umlaufende Flansch dient nicht zur Anlage auf der Resektionsfläche, wie dies beispielsweise bei der proximalen Druckscheibe gemäß der DE-A 27 24 234 der Fall ist. To be noted here is the following: the encircling flange on the two cone bases not intended for bearing on the resection surface, as is the case for example with the proximal thrust washer according to DE-A 27 24 234th Idealerweise befindet sich zwischen der Resektionsfläche und der dieser zugewandten Seite des Flansches nach Herstellung der konischen Klemmverbindung zur implantierten Hülse ein Spalt von etwa 1 mm Breite. Ideally, is located between the resection surface and the facing this side of the flange after the production of the conical clamping connection to the implanted sleeve, a gap of about 1 mm width. Dieser wird nach der Implantation im Laufe der Zeit von Knochentrapekeln durchwachsen werden, wenn der Flansch auf seine nach außen weisenden Flächen mit einer offenmaschigen dreidimensionalen Raumnetzstruktur belegt ist. This will be mixed after implantation over time by bone trabeculae, when the flange is coated on its outwardly facing surfaces with an open-meshed three-dimensional spatial network structure. Diese Arretierung dient lediglich der Festlegung des Adapters, nicht der Krafteinleitung von Belastungskräften in die Kortikalis des Femurs. This locking serves only to establish the adapter, not the force introduction of loading forces in the cortex of the femur. Alternativ wäre auch eine Festlegung mittels Schrauben denkbar. Alternatively, a fixing by means of screws would be conceivable.

Im Falle eines notwendig werdenden Revisionseingriffes paßt in den angesprochenen Spalt das Sägeblatt einer Säge, mit welcher die Knochentrapekel zwischen Adapter, Flansch und Resektionsfläche einfach durchtrennt werden können, so daß der Adapter aus der Hülse mittels eines Abziehwerkzeuges einfach abgezogen werden kann. In the case of a revision procedure become necessary in the mentioned gap, the saw blade of a saw with which the trabecular bones between adapter flange and resection can be easily severed so that the adapter from the sleeve can be easily removed by means of a Abziehwerkzeuges fits.

Der Adapter kann durch eine weitere vorteilhafte Maßnahme weiter in seinem konischen Klemmsitz gesichert werden, dadurch, daß im der Hülse zuzuwendenden Steckkonus des Adapters eine Sackbohrung mit Innengewinde vorgesehen ist, mit welchem das Ende der mit einem entsprechenden Gewindeabschnitt versehenen Zugschraube zur Arretierung verschraubbar ist. The adapter can be secured by a further advantageous measure further in its conical clamping fit, characterized in that a blind bore is provided with an internal thread in the sleeve is to face plug cone of the adapter with which the end of the provided with a corresponding threaded portion of the lag screw for locking can be screwed. In diesem Falle greift also die Zugschraube durch das Innere der Hülse weit über das Gewinde hinaus, mit welchem die Zugplatte mit der Hülse mittels der Zugschraube verschraubbar ist, nämlich bis weit hinein in den Bereich der proximalen Steckhülse. In this case, therefore, the lag screw engages through the inside of the sleeve far beyond the thread with which the tension plate to the sleeve can be screwed by means of the lag screw, namely far into the region of the proximal socket. Der Steckkonus des Adapters wird in diesem Falle also regelrecht in die konische Klemmhülse der Hülse im Femur durch die Zugschraube hineingezogen und dort unverrückbar festgelegt. The plug cone of the adapter is thus literally dragged into this case in the conical clamping sleeve of the sleeve in the femur through the lag screw and fixed there immovable.

Damit es nach Herstellung der Verbindung zwischen Hülse und Zugplatte außen an der Kortikalis des Femurs nicht zu deren Lockerung kommt beim Herstellen der Verbindung zwischen dem Adapter und der Hülse, weist der Gewindeabschnitt am Ende der Zugschraube vorzugsweise eine andere Steigung auf als das Gewinde im Inneren der Hülse. So that it does not come after the connection between the sleeve and a tension plate on the outside of the cortex of the femur to the loosening when the connection between the adapter and the sleeve, the threaded portion at the end of the lag screw, preferably a different pitch than the thread in the interior of the sleeve. Hierdurch wird ein Selbstkontereffekt erzielt, der eben eine Lockerung der zuerst hergestellten Verbindung unterbindet. In this way, a self locking effect is achieved which just prevents a loosening of the connection produced first.

Gemäß einer noch weiteren vorteilhaften Ausführungsform der Schenkelhalsendoprothese ist vorgesehen, daß die den Femur zuzuwendenden Flächen der Zugplatte ebenfalls mit einer offenmaschigen dreidimensionalen Raumnetzstruktur belegt sind. According to yet another advantageous embodiment of the femoral neck is provided, that the femur is to face surfaces of the draw plate are also coated with an open-meshed three-dimensional spatial network structure. Hierdurch erfolgt eine weitere Festlegung des Implantates gegenüber Mikrobewegungen bei Belastungen. This results in a further determination of the implant to micro-movements under load. Theoretisch könnte zwar auf die Zugplatte nach einem vollständigen Einheilen der Hülse im Spongiosaraum des Femurs verzichtet werden, da diese Fixationsart zu einem äußerst innigen Verbund zwischen Implantat und der Knochenumgebung führt. theoretically could be dispensed with the tension plate after complete healing of the sleeve Spongiosaraum of the femur, as these Fixationsart leads to an extremely intimate bond between the implant and the bone environment. Überlegungen hinsichtlich einer Langzeitfixation und hinsichtlich der Vermeidung eines unnötigen Risikos können es jedoch erwünscht erscheinen lassen, diese zusätzliche Sicherungsmaßnahme an der Zugplatte vorzusehen. However, considerations of a long-term fixation and in terms of preventing an unnecessary risk can appear desirable to provide this additional security measure on the tension plate it.

Eine weitere Sicherungsmaßnahme hinsichtlich der Lage der Zugplatte an der lateralen Kortikalis des Femurs ist vorteilhaft dann gegeben, wenn die Zugplatte mit wenigstens einem in Richtung des Femurs weisenden Widerlager in Form eines Zapfens versehen ist, welcher mit der Zugplatte im wesentlichen denselben Winkel einschließt wie die Hauptachse der Hülse mit der Zugplatte, wobei unter der Achse der Zugplatte deren Hauptachse zu verstehen ist. A further security measure with regard to the position of the tension plate on the lateral cortex of the femur is advantageously achieved when the tension plate is provided in the form of a pin having at least one facing in the direction of the femur abutment, which forms with the tension plate substantially the same angle as the major axis of the sleeve with the tension plate, said tension plate below the axis of the major axis is to be understood. Das Widerlager wirkt rotationshemmend. The abutment acts rotation locking. Gleichzeitig können etwaige Biegemomente abgelastet werden. At the same time any bending moments can be derated.

Die Erfindung wird anhand eines Ausführungsbeispiels näher erläutert. The invention will be explained in more detail using an exemplary embodiment. Hierbei zeigt: Here shows:

Fig. 1 Fig. 1
die Schnittansicht einer im Femur zu implantierenden Hülse der Endoprothese, the sectional view of an appliance to be implanted in the femur sleeve of the endoprosthesis,
Fig. 2 Fig. 2
die Schnittansicht der Zugplatte der Endoprothese, the sectional view of the tension plate of the endoprosthesis,
Fig. 3 Fig. 3
die Ansicht der Zugschraube, the view of the lag screw,
Fig. 4 Fig. 4
die Ansicht in Richtung des Pfeils IV in Fig. 1 auf das proximale Ende der Hülse, the view in the direction of the arrow IV in Fig. 1 on the proximal end of the sleeve,
Fig. 5 Fig. 5
die Ansicht des Adapters zur Aufnahme einer künstlichen Gelenkkugel, teilweise im Schnitt, the view of the adapter for accommodating an artificial joint ball, partially in section,
Fig. 6 Fig. 6
die Komponenten der Endoprothese aus den Figuren 1 bis 5 in schematisch dargestellter Lagebeziehung entsprechend der Lagebeziehung bei der Implantation, und the components of the endoprosthesis of Figures 1 to 5, in a schematically represented positional relationship corresponding to the positional relationship in the implantation and
Fig. 7 Fig. 7
die schematisch dargestellte Implantationslage der Endoprothese in dem Schenkelhals eines Femurs. the implantation location of the endoprosthesis in the neck of a femur, shown schematically.

Nachfolgend sind dieselben Teile mit denselben Bezugszeichen versehen. Subsequently, the same parts are given the same reference numerals.

In Fig. 1 ist die Hülse 1 der erfindungsgemäßen Endoprothese dargestellt. In Fig. 1, the sleeve 1 of the endoprosthesis according to the invention. Die Hülse weist ein proximales Ende 8 und ein distales Ende 6 auf. The sleeve has a proximal end 8 and a distal end. 6 Im dargestellten Ausführungsbeispiel verläuft die Hülse von ihrem proximalen Ende 8 hin zu ihrem distalen Ende 6 sich konisch verjüngend, was die erwünschten Effekte hinsichtlich der Kraftverteilung bewirkt. In the illustrated embodiment, the sleeve 8 extends from its proximal end towards conically tapered to its distal end 6, which causes the desired effects with regard to the force distribution. Die im Schnitt dargestellte Hülse 1 ist auf ihren Außenflächen vorliegend mit einer offenmaschigen dreidimensionalen Raumnetzstruktur 9 relativ grober Maschenweite (3 bis 6 mm) belegt, und zwar auf den Hülsenaußenseiten, die nach Implantation im Femur nach kaudal und nach kranial zeigen. The sleeve 1 shown in section (3 to 6 mm) is on their outer surfaces herein with an open-meshed three-dimensional spatial network structure 9 of relatively coarse mesh size, on the sleeve outer sides pointing to the implantation in the femur to caudal and cephalad. Dies entspricht in anatomischer Adaption in etwa den Größen der natürlichen Knochentrapekel in diesem im Schenkelhals. This corresponds to an anatomical adaptation approximately the sizes of natural trabecular bones in this in the femoral neck.

Auf den nach ventral und dorsal weisenden Hülsenaußenseiten (Fig. 4) ist zwar ebenfalls eine offenmaschige dreidimensionale Raumnetzstruktur vorgesehen, jedoch mit wesentlich geringerer Maschenweite, wie dies in Fig. 4 schematisch dargestellt ist. Although an open-mesh three-dimensional spatial network structure is also provided on the ventral and dorsal facing sleeve outer sides (Fig. 4), but with a much smaller mesh, as shown schematically in Fig. 4. Diese Maschenweiten betragen zwischen 1 bis 2,5 mm. These mesh sizes are between 1 to 2.5 mm.

Im distalen Ende 6 der Hülse 1 ist eine Durchbohrung 5 vorgesehen, der sich in Richtung auf das proximale Ende 8 der Hülse 1 ein Innengewinde 7 anschließt. In the distal end 6 of the sleeve 1 a through bore 5 is provided, which adjoins in the direction of the proximal end 8 of the sleeve 1 has an internal thread. 7 Dieses geht über in eine zylindrische Bohrung, welche schließlich in einer konischen Klemmhülse 12 am proximalen Ende 8 endet. This merges into a cylindrical bore, which finally ends in a conical clamping sleeve 12 at the proximal end. 8

Eine weitere wichtige Komponente der Endoprothese ist die Zugplatte 3, wie sie in beispielhafter Ausführungsform in Fig. 2 in Schnittansicht gezeigt ist. Another important component of the endoprosthesis is the tension plate 3, as shown in exemplary embodiment in FIG. 2 in a sectional view. Sie besteht im wesentlichen aus einem plattenförmigen Element, welches eine Durchbohrung 21 aufweist zur Durchführung einer Zugschraube, wie weiter unten noch näher erläutert werden wird. It consists essentially of a plate-shaped member having a through bore 21 for performing a lag screw, as will be explained in more detail below.

Sie weist auf ihrer dem Femur zuzuwendenden Fläche eine offenmaschige dreidimensionale Raumnetzstruktur auf, durch welche Knochentrapekel ausgehend von der Kortikalis des Femurs hindurchwachsen, um eine Lagefixierung der Zugplatte 3, aber auch der mit ihr nach der Implantation verbundenen Hülse 1 zu erreichen. It has their made facing the femur surface on an open-mesh three-dimensional spatial network structure, through which trabecular bones grow through starting from the cortex of the femur in order to achieve a positional fixing of the tension plate 3 but also its associated after implantation sleeve. 1

Wie ersichtlich, weist die Zugplatte 3 femurwärts ein Widerlager in Form eines Zapfens 18 auf, der hier im selben Winkel geneigt ist wie die Hauptachse der Hülse 1 zur Zugplatte 3. As can be seen, the tension plate 3 the femur an abutment in the form of a pin 18 which is inclined here at the same angle as the main axis of the sleeve 1 for the tension plate. 3

Hierdurch wird eine besondere Stabilität hinsichtlich etwaig angreifender Biegemomente erzielt. This results in a higher stability is achieved with regard to possible attacking bending moments.

Fig. 3 zeigt eine Ansicht der Zugschraube 4. Diese weist ausgehend von ihrem Kopf 19 vier Abschnitte auf. Fig. 3 shows a view of the lag screw 4. This has, starting from her head to 19 four sections. Zunächst schließt sich dem Kopf 19 ein zylindrischer Abschnitt 15 mit verringertem Durchmesser gegenüber dem sich daran anschließenden zylindrischen Abschnitt 22 auf. Initially, 19, a cylindrical portion 15 closes the head of reduced diameter relative to the adjoining cylindrical portion 22nd Dieser wiederum folgt ein Gewindeabschnitt 7', dem sich ein weiterer Gewindeabschnitt 14' anschließt. This in turn is followed by a threaded portion 7 ', which another threaded section 14,' followed. Der Gewindeabschnitt 7' arbeitet mit dem Innengewinde 7 in der Hülse 1 zusammen, wenn nämlich die Zugschraube 4 durch die Zugplatte 3 und die Bohrung in der Kortikalis des Femurs durch die Durchbohrung 5 in der Hülse 1 hindurchgeführt wird. The threaded portion 7 'cooperates with the inner thread 7 of the sleeve together in 1, namely, when the lag screw 4 by the tension plate 3 and the hole in the cortex of the femur passes through the through bore 5 in the sleeve. 1 Die Zugschraube 4 zieht sozusagen die Hülse 1 vermittels der Zugplatte 3 nach lateral in ihre Implantationslage. The lag screw 4 as it were draws the sleeve 1 by means of the tension plate 3 laterally in its implantation location. Der durchmesserreduzierte Abschnitt 15 dient zur Feineinstellung der Lage der Zugschraube 4 in der Zugplatte 3 in deren Durchbohrung 21. The reduced diameter portion 15 is used for fine adjustment of the position of the lag screw 4 in the tension plate 3 in the bore 21st

Der distale Gewindeabschnitt 14' der Zugschraube 4 arbeitet mit dem Adapter 2 zusammen, wie er beispielhaft in Fig. 5 teilweise im Schnitt dargestellt ist. The distal threaded portion 14 'of the lag screw 4 co-operates with the adapter 2, as it is exemplary shown partially in Fig. 5 in section. Der Adapter 2 besteht vorliegend aus zwei Steckkonen 10 und 10' die voneinander wegragen. The adapter 2 is made herein of two plug-in cones 10 and 10 'which project from each other. Der Steckkonus 10 ist dazu vorgesehen, in die Steckhülse 12 der Hülse gesetzt zu werden und dort unter der Wirkung der entstehenden konischen Klemmverbindung zu verharren. The plug-in cone 10 is intended to be placed in the receptacle 12 of the sleeve and to remain there, under the effect of the resulting conical clamping connection. Zur weiteren Lagesicherung ist im Steckkonus 10 eine Sackbohrung 13 mit einem Innengewinde 14 vorgesehen. To further secure the position a blind bore 13 is provided with an internal thread 14 in the plug-in cone 10th Mit diesem Innengewinde 14 wird der Gewindeabschnitt 14' der Zugschraube 4 verschraubt. This internal thread 14 of the threaded portion 14 'of the lag screw 4 is screwed.

Mit dem anderen Steckkonus 10' ist in herkömmlicherweise eine künstliche Gelenkkugel verbindbar, ebenfalls unter der Wirkung einer zwischen dem Konus 10' und einer Steckhülse in der Gelenkkugel herzustellenden konischen Klemmverbindung. With the other plug-in cone 10 'is an artificial joint ball can be connected in a conventional manner, also under the action of the cone between 10' to be produced and a socket in the ball joint conical clamping connection.

Im Bereich der Basen der Konen 10 und 10' des Adapters 2 ist ein umlaufender Flansch 11 ausgebildet. In the area of ​​the bases of the cones 10 and 10 'of the adapter 2, a circumferential flange 11 is formed. Dieser Flansch dient - wie weiter oben bereits ausgeführt - nicht dazu, eine Ablastung auf der Resektionsfläche des Femurs zu bilden. This flange is used - as already stated above - not to form a been downsized to the resection of the femur. Dieser Flansch dient lediglich der Rotationssicherung. This flange is only for rotational stability. Zu diesem Zweck sind in dem Flansch 11 einige periphere Bohrungen 23 vorgesehen, durch welche hindurch geeignete Befestigungsmittel (nicht dargestellt) gesetzt werden können, um eine Rotationssicherung durchzuführen. For this purpose, some peripheral holes 23 are provided in the flange 11 through which suitable attachment means may be placed (not shown), to perform rotation lock. Beispielsweise könnten kleine Schrauben in den Femur durch die Bohrungen 23 hindurchgeführt werden. For example, small screws may be passed into the femur through the holes 23rd Alternativ hierzu oder zusätzlich zu dieser Befestigungsmöglichkeit ist vorgesehen, daß die nach außen weisenden Flächen des Flansches 11 mit einer offenmaschigen dreidimensionalen Raumnetzstruktur 16 belegt sind. Alternatively, or in addition to these fastening possibility is provided that the outwardly facing surfaces of the flange 11 are covered with an open-meshed three-dimensional spatial network structure sixteenth Nach der Implantation der Endoprothese werden Knochentrapekel von der Resektionsfläche des Femurs in diese Raumstrukturen hineinwachsen bzw. diese durchwachsen und so zu einer Rotationsstabilität führen. After implantation of the endoprosthesis trabecular bones will grow from the resection of the femur in this room structures and thus lead these mixed and a rotational stability.

Bevorzugt erfolgt die Implantation der Endoprothese so, daß zwischen der Resektionsfläche und dem Flansch 11 ein Spalt von beispielsweise 1 mm frei bleibt. the implantation of the endoprosthesis is preferably carried out so that remains free between the resection surface and the flange 11, a gap of for example 1 mm. Dieser Spalt kann problemlos von den Knochentrapekeln überwundet werden, andererseits jedoch bei einem Revisionseingriff leicht durch ein in diesen Spalt hineinzuführendes Sägeblatt wieder aufgetrennt werden. This gap can be easily überwundet of the bone trabeculae, on the other hand, however, be easily separated during a revision surgery by a hineinzuführendes into this gap blade again.

Aus Fig. 6 ergibt sich schematisch der Effekt der Zusammenwirkung der vorbeschriebenen Komponenten der Endoprothese. From Fig. 6, the effect of the interaction of the above components of the endoprosthesis gives schematically.

Bei der Implantation befindet sich zwischen der Zugplatte 3 und der Hülse 1 die laterale Kortikalis des Femurs (nicht dargestellt). In the implantation, the lateral cortex of the femur located between the draw plate 3 and the sleeve 1 (not shown). Die Zugschraube 4 wird durch die Durchbohrung 21 in der Zugplatte 3 und durch die Bohrung in der Kortikalis in die Hülse 1 geführt. The lag screw 4 is guided through the through bore 21 in the tension plate 3 and through the hole in the cortical bone into the sleeve. 1 Sodann wird der Gewindeabschnitt 7' der Zugschraube 4 mit dem Innengewinde 7 in der Hülse 1 verschraubt, wobei die Hülse 1 dann nach außen (lateral) gezogen wird. Is then screwed to the threaded portion 7 'of the lag screw 4 with the internal thread 7 in the sleeve 1, the sleeve 1 is then pulled outward (lateral). Danach kann der Adapter 2 an die Hülse 1 herangebracht werden unter Einsetzen des Steckkonus 10 des Adapters 2 in die Steckhülse 12 in der Hülse 1. Dies geschieht im dargestellten Fall durch ein Einschrauben des Adapters, wobei der Gewindeabschnitt 14' der Zugschraube 4 mit dem Innengewinde 14 in Steckkonus 10 verschraubt wird. Thereafter, the adapter 2 can be brought to the sleeve 1 by insertion of the male taper 10 of the adapter 2 in the socket 12 in the sleeve 1. This is done in the illustrated case by screwing the adapter with the threaded portion 14 'of the lag screw 4 with the internal thread is screwed in plug-in cone 10 fourteenth

Eine Rotationsstabilität der Hülse 1 wird von vorn herein durch die ovale Querschnittsform erzielt, welche sich vorliegend aus der Belegung der Außenflächen der Hülse 1 mit offenmaschigen dreidimensionalen Raumnetzstrukturen mit unterschiedlichen Maschenweiten - wie beschrieben - ergibt. A rotational stability of the sleeve 1 is achieved from the outset by the oval cross-sectional shape, which in the present case of the occupancy of the outer surfaces of the sleeve 1 with open-meshed three-dimensional spatial network structures with different mesh sizes - yields - as described.

Schließlich sei auf Fig. 7 kurz hingewiesen, aus der heraus sich die Lage der Endoprothese in situ schematisch ergibt. Finally, it should briefly to FIG. 7, the position of the endoprosthesis in situ results from which schematically. Zusätzlich dargestellt ist eine künstliche Gelenkkugel 20, die mit einer künstlichen Gelenkpfanne zusammenwirkt, um ein künstliches Hüftgelenk zu ergeben. Additionally illustrated is an artificial joint ball 20, which cooperates with an artificial joint socket to give an artificial hip joint. Die Darstellung in Fig. 7 dient lediglich der Anschauung. The illustration in Fig. 7 is merely illustrative.

Claims (10)

  1. Femoral neck endoprosthesis for an artificial hip joint having
    a shell (1) which can be implanted without cement in the upper region of a femur below the greater trochanter, the proximal end (8) of the shell being connected with an adapter (2) for accommodating an artificial spherical part of a joint (20), whereby the exterior of the shell is at least partially covered with an open-meshed three-dimensional spatial lattice structure (9), as well as
    a draw plate (3) on which a draw-in screw (4) is fastened, which is placed in the interior of the shell (1) through a through bore (5) in its distal end (6), and which is screwed in with a thread (7) provided therein, wherein
    it does not have a fastening plate on the proximal side for introducing compressive forces on the cortex of the femur.
  2. Femoral neck endoprosthesis according to claim 1, wherein the shell (1) is constructed as tapering conically from its proximal end (8) to its distal end (6).
  3. Femoral neck prosthesis according to claim 1, wherein the spatial lattice structure (9) is constructed with a coarse mesh having mesh widths between 3 to 6 mm on the shell exterior sides which point in caudal and cranial directions.
  4. Femoral neck endoprosthesis according to one of claims 1 to 3, wherein the spatial lattice structure (9) is constructed with a fine mesh having mesh widths between 1 to 2.5 mm in ventral and dorsal directions on the shell exterior side.
  5. Femoral neck endoprosthesis according to one of claims 1 to 4, wherein the adapter (2) for the spherical joint part is constructed essentially as a double plug cone (10, 10') having an annular flange (11) on the bases of the two cones, wherein a conical plug socket (12) constructed corresponding to the one plug cone (10) is provided in the proximal area of the shell (1).
  6. Femoral neck endoprosthesis according to claim 5, wherein a blind bore (13) having an internal thread (14) is provided in the plug core (10) of the adapter (2) facing the shell (1), with which the end of the draw-in screw (4), provided with a corresponding thread section (14'), can be screwed in for arrestation.
  7. Femoral neck prosthesis according to claim 6, wherein the thread section (14') at the end of the draw-in screw (4) has a different pitch than the thread (7) in the interior of the shell (1).
  8. Femoral neck prosthesis according to one of claims 1 to 7, wherein outward facing surfaces of the flange (11) of the adapter (2) are covered with an open-meshed three-dimensional spatial lattice structure (16).
  9. Femoral neck prosthesis according to one of claims 1 to 8, wherein surfaces of the draw plate (3) facing the femur are covered with an open-meshed three-dimensional spatial lattice structure (17).
  10. Femoral neck endoprosthesis according to one of claims 1 to 9, wherein the draw plate (3) is provided with at least one abutment in a form of a peg (18) pointing in the direction of the femur, which essentially forms the same angle α with the draw plate as the main axis of the shell with the draw plate.
EP19970100111 1996-01-16 1997-01-07 Femoral neck endoprosthesis for an artificial hip joint Expired - Lifetime EP0791342B1 (en)

Priority Applications (2)

Application Number Priority Date Filing Date Title
DE19601340 1996-01-16
DE1996101340 DE19601340C1 (en) 1996-01-16 1996-01-16 Endoprosthesis for neck of femur for artificial hip joint

Publications (2)

Publication Number Publication Date
EP0791342A1 EP0791342A1 (en) 1997-08-27
EP0791342B1 true EP0791342B1 (en) 1999-07-28

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Application Number Title Priority Date Filing Date
EP19970100111 Expired - Lifetime EP0791342B1 (en) 1996-01-16 1997-01-07 Femoral neck endoprosthesis for an artificial hip joint

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US (1) US5766263A (en)
EP (1) EP0791342B1 (en)
JP (1) JPH09289996A (en)
AT (1) AT182456T (en)
DE (1) DE19601340C1 (en)
ES (1) ES2134656T3 (en)

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Also Published As

Publication number Publication date
EP0791342A1 (en) 1997-08-27
AT182456T (en) 1999-08-15
US5766263A (en) 1998-06-16
ES2134656T3 (en) 1999-10-01
JPH09289996A (en) 1997-11-11
DE19601340C1 (en) 1997-06-05

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